Impact of heart failure on stroke mortality and recurrence

Pana, Tiberiu A., Wood, Adrian D., Perdomo-Lampignano, Jesus A., Tiamkao, Somsak, Clark, Allan B., Kongbunkiat, Kannikar, Bettencourt-Silva, Joao H., Sawanyawisuth, Kittisak, Kasemsap, Narongrit, Mamas, Mamas A. and Myint, Phyo K. (2019) Impact of heart failure on stroke mortality and recurrence. Heart Asia, 11 (1). ISSN 1759-1104

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Abstract

Objective We aimed to examine the impact of heart failure (HF) on stroke mortality (in-hospital and postdischarge) and recurrence in a national stroke cohort from Thailand. Methods We used a large, insurance-based database including all stroke admissions in the public health sector in Thailand between 2004 and 2015. Logistic and Royston-Parmar regressions were used to quantify the effect of HF on in-hospital and long-Term outcomes, respectively. All models were adjusted for age, sex and comorbidities and stratified by stroke type: Acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Multistate models were constructed using flexible survival techniques to predict the impact of HF on the disease course of a patient with stroke (baseline-[recurrence]-death). Only first-ever cases of AIS or ICH were included in the multistate analysis. Results 608 890 patients (mean age 64.29±13.72 years, 55.07% men) were hospitalised (370 527 AIS, 173 236 ICH and 65 127 undetermined pathology). There were 398 663 patients with first-ever AIS and ICH. Patients were followed up for a median (95% CI) of 4.47 years (4.45 to 4.49). HF was associated with an increase in postdischarge mortality in AIS (HR [99% CI] 1.69 [1.64 to 1.74]) and ICH (2.59 [2.07 to 3.26]). HF was not associated with AIS recurrence, while ICH recurrence was only significantly increased within the first 3 years after discharge (1.79 [1.18 to 2.73]). Conclusions HF increases the risk of mortality in both AIS and ICH. We are the first to report on high-risk periods of stroke recurrence in patients with HF with ICH. Specific targeted risk reduction strategies may have significant clinical impact for mortality and recurrence in stroke.

Item Type: Article
Uncontrolled Keywords: brain infarction,cerebral haemorrhage,cerebrovascular disorders,heart failure,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 12 Jun 2019 15:30
Last Modified: 10 Jun 2020 00:19
URI: https://ueaeprints.uea.ac.uk/id/eprint/71357
DOI: 10.1136/heartasia-2018-011139

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